Ma Ying-chun, Zuo Li, Wang Mei, Zhou Yu-hong, Zhang Chun-li, Xu Guo-bin, Wang Hai-yan
Institute of Nephrology and Division of Nephrology, the First Hospital, Peking University, Beijing 100034, China.
Zhonghua Nei Ke Za Zhi. 2005 Apr;44(4):285-9.
To understand the applicability of MDRD equation in Chinese patients with chronic kidney disease (CKD). Glomerular filtration rate (GFR) estimated with MDRD equation, abbreviated MDRD equation and Cockcroft-Gault equation was compared with (99m)Tc-DTPA plasma clearance by dual plasma sampling method in different stages of CKD.
CKD were diagnosed according to K/DOQI guideline.298 patients with CKD were selected. Patients'sex, age, height and body weight were recorded and plasma creatinine, urea nitrogen and albumin were measured in a single clinical laboratory. (99m)Tc-DTPA plasma clearance was calculated and standardized by body surface area (sGFR). GFRs estimated with MDRD equation 7, abbreviated MDRD equation and Cockcroft-Gault equation (7GFR, aGFR and cGFR) were compared with sGFR in different stages of CKD.
There were 165 male and 133 female in the selected 298 patients with CKD;the average age was (52.5 +/- 15.5) years. There was significant difference between the GFRs of the 3 equations with sGFR in different stages of CKD (P < 0.001). 7GFR, aGFR and cGFR were significantly higher than sGFR in CKD stages 5-4; the lower the sGFR, the more the differences. 7GFR, aGFR and cGFR were significantly lower than sGFR in CKD stage 2-1; the higher the sGFR, the more the differences.
Our results showed that in Chinese population with CKD, MDRD equation 7, abbreviated MDRD equation and Cockcroft-Gault equation overestimate actual GFR in CKD stages 4-5 and underestimate GFR in CKD stages 1-2. These results indicate that MDRD equation and its modifications for estimation of GFR should be amended when applying to Chinese patients with CKD in clinical practice.
了解MDRD方程在中国慢性肾脏病（CKD）患者中的适用性。将采用MDRD方程、简化MDRD方程和Cockcroft-Gault方程估算的肾小球滤过率（GFR），与采用双血浆采样法测定的不同阶段CKD患者的（99m）Tc-DTPA血浆清除率进行比较。
根据K/DOQI指南诊断CKD。选取298例CKD患者，记录患者的性别、年龄、身高和体重，并在单一临床实验室测定血浆肌酐、尿素氮和白蛋白。计算并根据体表面积标准化（99m）Tc-DTPA血浆清除率（sGFR）。将采用MDRD方程7、简化MDRD方程和Cockcroft-Gault方程估算的GFR（7GFR、aGFR和cGFR）与不同阶段CKD患者的sGFR进行比较。
入选的298例CKD患者中，男性165例，女性133例；平均年龄为（52.5±15.5）岁。在不同阶段的CKD中，3种方程估算的GFR与sGFR之间存在显著差异（P<0.001）。在CKD 5-4期，7GFR、aGFR和cGFR显著高于sGFR；sGFR越低，差异越大。在CKD 2-1期，7GFR、aGFR和cGFR显著低于sGFR；sGFR越高，差异越大。
我们的结果表明，在中国CKD患者中，MDRD方程7、简化MDRD方程和Cockcroft-Gault方程在CKD 4-5期高估了实际GFR，而在CKD 1-2期低估了GFR。这些结果表明，在临床实践中应用于中国CKD患者时，MDRD方程及其估算GFR的修正公式应进行调整。
